Provider Demographics
NPI:1093902033
Name:LACORTIGLIA, JENNIFER G (LISW S)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:G
Last Name:LACORTIGLIA
Suffix:
Gender:F
Credentials:LISW S
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:GL
Other - Last Name:DUDICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11575 LOWER CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9308
Mailing Address - Country:US
Mailing Address - Phone:440-212-4278
Mailing Address - Fax:
Practice Address - Street 1:11575 LOWER CHELSEA DR
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9308
Practice Address - Country:US
Practice Address - Phone:440-212-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI05000231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical